Citation Nr: 0723489
Decision Date: 07/30/07 Archive Date: 08/14/07
DOCKET NO. 97-29 435 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Manila, the
Republic of the Philippines
THE ISSUES
Entitlement to service connection for residuals of gunshot
wound to the abdomen.
REPRESENTATION
Appellant represented by: Samuel L. Hart, Attorney
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
L. M. Barnard, Counsel
INTRODUCTION
The veteran had active service from April 1946 to February
1949.
This appeal arose before the Board of Veterans' Appeals
(Board) from a May 1996 rating decision of the Manila
Department of Veterans Affairs (VA), Regional Office (RO),
which found that the veteran had not submitted sufficient new
and material evidence, since a September 1994 Board denial,
to reopen his claim. In January 1998, the veteran testified
at a personal hearing at the Los Angeles RO.
In February 1999, the Board issued a decision which found
that the veteran had not submitted sufficient new and
material evidence to reopen his claim for service connection
for the residuals of a gunshot wound to the abdomen. The
veteran appealed that decision to the Court of Appeals for
Veterans Claims (CAVC). In January 2001, a Joint Motion for
Remand indicated the need for the case to be remanded to the
Board so that the provisions of the Veterans Claims
Assistance Act of 2000 (Nov. 9, 2000) could be complied with.
In February 2001, the CAVC issued an Order consistent with
the Joint Motion. Copies of the Joint Motion and the Court's
Order are in the claims folder.
In March 2002, the Board issued a Development Memorandum,
instructing the RO to carry out needed development,
consistent with 38 C.F.R. § 19.9(a)(2) (2002). However, on
May 1, 2003, the United States Court of Appeals for the
Federal Circuit invalidated 38 C.F.R. § 19.9(a)(2), in
Disabled American Veterans v. Secretary of Veterans Affairs,
327 F.3d 1339 (Fed. Cir. 2003). As a consequence, this case
was remanded by the Board to the RO for additional
development in September 2003.
In December 2005, the Board had issued a decision which found
that the veteran had submitted sufficient new and material
evidence to reopen his claim for service connection for the
residuals of a gunshot wound to the abdomen, and which then
remanded the issue of service connection for additional
development. The case is again before the Board for further
appellate consideration.
FINDING OF FACT
The veteran suffered a gunshot wound to the abdomen prior to
service, which did not increase in disabling severity as a
result of his service.
CONCLUSIONS OF LAW
1. A gunshot wound to the abdomen clearly and unmistakably
existed prior to service. 38 U.S.C.A. §§ 1110, 1111, 1131,
5103(a), 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §
3.159 (2006).
2. The veteran's pre-existing gunshot wound residuals were
not aggravated during his service. 38 U.S.C.A. §§ 1110, 1131,
1153, 5103(a), 5103A, 5107 (West 2002 & Supp. 2007); 38
C.F.R. §§ 3.159, 3.306(a)-(c) (2006).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Duty to notify and assist
The Veterans Claims Assistance Act of 2000 (VCAA) enhanced
VA's duty to notify and assist claimants in substantiating
their claims for VA benefits, as codified in pertinent part
at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2006);
38 C.F.R. § 3.159, 3.326(a) (2006).
Upon receipt of a complete or substantially complete
application for benefits, VA is required to notify the
claimant of the information and evidence not of record that
is necessary to substantiate the claim; to indicate which
information and evidence VA will obtain and which information
and evidence the claimant is expected to provide; and to
request that the claimant provide any evidence in the
claimant's possession that pertains to the claim. 38
U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The U.S. Court of
Appeals for Veterans Claims has held that VCAA notice should
be provided to a claimant before the initial RO decision on a
claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004).
However, if VCAA notice is provided after the initial
decision, such a timing error can be cured by subsequent
readjudication of the claim, as in a Statement of the Case
(SOC) or Supplemental SOC (SSOC). Mayfield v. Nicholson, 20
Vet. App. 537, 543 (2006).
The VCAA notice requirements apply to all five elements of a
service connection claim: (1) veteran status; (2) existence
of disability; (3) connection between service and the
disability; (4) degree of disability; and (5) effective date
of benefits where a claim is granted. Dingess v. Nicholson,
19 Vet. App. 473, 484 (2006).
The U.S. Court of Appeals for the Federal Circuit recently
held that any error in a VCAA notice should be presumed
prejudicial. The claimant bears the burden of demonstrating
such error. VA then bears the burden of rebutting the
presumption, by showing that the essential fairness of the
adjudication has not been affected because, for example,
actual knowledge by the claimant cured the notice defect, a
reasonable person would have understood what was needed, or
the benefits sought cannot be granted as a matter of law.
Sanders v. Nicholson, No. 06-7001 (Fed. Cir. May 16, 2007).
In November 2003, March and November 2004, and February and
May 2006, the RO sent the veteran letters informing him of
the types of evidence needed to substantiate his claims and
its duty to assist him in substantiating his claims under the
VCAA. These letters informed the veteran that VA would
assist him in obtaining evidence necessary to support his
claim, such as records in the custody of a Federal department
or agency, including VA, the service department, the Social
Security Administration, and other pertinent agencies. He
was advised that it was his responsibility to send medical
records showing he has a current disability as well as
records showing a relationship between his claimed
disabilities and service, or to provide a properly executed
release so that VA could request the records for him. The
veteran was also specifically asked to provide to provide
"any evidence in your possession that pertains to your
claim." See 38 C.F.R. § 3.159(b)(1).
The Board finds that the content of these letters provided to
the veteran complied with the requirements of 38 U.S.C.A.
§ 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to
notify and assist. He was advised of his opportunities to
submit additional evidence. Subsequently, February 2005 and
November 2006 SSOC's provided him with yet an additional 60
days to submit more evidence. Thus, the Board finds that the
purpose behind the notice requirement has been satisfied
because the veteran has been afforded a meaningful
opportunity to participate effectively in the processing of
his claim. In addition, it appears that all obtainable
evidence identified by the veteran relative to his claim has
been obtained and associated with the claims file, and that
neither he nor his representative has identified any other
pertinent evidence, not already of record, which would need
to be obtained for a fair disposition of this appeal. It is
therefore the Board's conclusion that the veteran has been
provided with every opportunity to submit evidence and
argument in support of his claims, and to respond to VA
notices.
Moreover, the claimant has not demonstrated any error in VCAA
notice, and therefore the presumption of prejudicial error as
to such notice does not arise in this case. See Sanders,
supra.
Accordingly, we find that VA has satisfied its duty to assist
the veteran in apprising him as to the evidence needed, and
in obtaining evidence pertinent to his claim under the VCAA.
Therefore, no useful purpose would be served in remanding
this matter for yet more development. Such a remand would
result in unnecessarily imposing additional burdens on VA,
with no additional benefit flowing to the veteran. The Court
of Appeals for Veterans Claims has held that such remands are
to be avoided. Sabonis v. Brown, 6 Vet. App. 426, 430
(1994).
In addition, to whatever extent the recent decision of the
Court in Dingess v. Nicholson, supra, requires more extensive
notice in claims for compensation, e.g., as to potential
downstream issues such as disability rating and effective
date, the Board finds no prejudice to the veteran in
proceeding with the present decision. Since the claims
herein are being denied, such matters are moot. Moreover,
the Board notes that he was sent notice of the provisions of
Dingess in March 2007.
II. Applicable laws and regulations
Service connection may be granted for disability which is the
result of disease or injury incurred in or aggravated by
service. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp. 2007);
38 C.F.R. § 3.303(a) (2006).
To establish service connection, there must be (1) medical
evidence of a current disability; (2) medical, or in certain
circumstances, lay evidence of in-service incurrence or
aggravation of a disease or injury; and (3) medical evidence
of a nexus between the claimed in-service disease or injury
and the current disability. See Hickson v. West, 12 Vet.
App. 247, 253 (1999).
A veteran will be considered to have been in sound condition
when examined, accepted, and enrolled for service, except as
to defects, infirmities, or disorders noted at entrance into
service, or where clear and unmistakable evidence
demonstrates that an injury or disease existed prior thereto
and was not aggravated by service. 38 U.S.C.A. § 1111. Only
such conditions as are recorded in examination reports are to
be considered as noted. 38 C.F.R. § 3.304(b).
A pre-existing disability or disease will be considered to
have been aggravated by active service when there is an
increase in disability during service, unless there is clear
and unmistakable evidence (obvious and manifest) that the
increase in disability is due to the natural progress of the
disability or disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306
(a), (b). Aggravation of a pre-existing condition may not be
conceded where the disability underwent no increase in
severity during service on the basis of all the evidence of
record pertaining to the manifestations of the disability
prior to, during, and subsequent to service. 38 U.S.C.A. §
1153; 38 C.F.R. § 3.306(b). See Falzone v. Brown, 8 Vet.
App. 398, 402 (1995) (holding that the presumption of
aggravation created by section 3.306 applies only if there is
an increase in severity during service); Akins v. Derwinski,
1 Vet. App. 228, 231 (1991).
The Board notes that the language of the aforementioned
regulation at 38 C.F.R. § 3.304(b) (2004) was amended during
the pendency of this appeal, effective May 4, 2005. See 70
Fed. Reg. 23,027-29 (May 4, 2005) (now codified at 38 C.F.R.
§ 3.304(b) (2006)). The amended regulation requires that VA,
rather than the claimant, bear the burden of proving that the
disability at issue pre-existed entry into service, and that
the disability was not aggravated by service, before the
presumption of soundness on entrance into active service may
be rebutted. See Wagner v. Principi, 370 F.3d 1089 (Fed.
Cir. 2004); Cotant v. Principi, 17 Vet. App. 116 (2003).
Where a law or regulation changes after a claim has been
filed, but before the administrative and/or appeal process
has been concluded, both the old and new versions must be
considered. See VAOPGCPREC 7-2003 (Nov. 19, 2003);
VAOPGCPREC 3-2000 (Apr. 10, 2000). The Board will therefore
consider both the old and new versions of 38 C.F.R. §
3.304(b), noting that the amended regulation establishes a
somewhat lesser burden upon the claimant.
Under longstanding law, once the presumption of soundness at
entry has been rebutted, aggravation may not be conceded
unless the pre-existing condition increased in severity
during service, pursuant to 38 C.F.R. § 3.306. See
VAOPGCPREC 3-2003 (July 16, 2003). In addition, the usual
effects of medical and surgical treatment in service,
provided to ameliorate a pre-existing condition, will not be
considered service connected unless the disorder is otherwise
aggravated by service. 38 C.F.R. § 3.306(b)(1).
Mere history provided by the veteran of the pre-service
existence of conditions recorded at the time of the entrance
examination does not, in itself, constitute a notation of a
preexisting condition. 38 C.F.R. § 3.304(b)(1); Paulson v.
Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet.
App. 238, 246 (1995). The Court of Appeals for Veterans
Claims has held that the presumption of soundness upon entry
into service may not be rebutted without "contemporaneous
clinical evidence or recorded history" in the record.
Miller v. West, 11 Vet. App. 345, 348 (1998). Subsequently,
a higher court explained the Miller decision by noting that
"[n]othing in the court's opinion suggests that without such
evidence the presumption can never be rebutted," emphasizing
that any such determination must consider "how strong the
other rebutting evidence might be." Harris v. West, 203 F.
3d. 1347, 1351 (Fed. Cir. 2000).
As noted, under 38 U.S.C.A. § 1111, the presumption of
soundness may be rebutted by clear and unmistakable evidence
that a disease or injury existed prior to service and was not
aggravated therein. The burden of proof is upon VA to rebut
the presumption by producing that clear and unmistakable
evidence. See Kinnaman v. Principi, 4 Vet. App. 20, 27
(1993). The determination of whether there is clear and
unmistakable evidence that a defect, infirmity, or disorder
existed prior to service should be based upon "thorough
analysis of the evidentiary showing and careful correlation
of all material facts, with due regard to accepted medical
principles pertaining to the history, manifestations,
clinical course, and character of the particular injury or
disease or residuals thereof." 38 C.F.R. § 3.304(b)(1).
Temporary or intermittent flare-ups during service of a pre-
existing injury or disease are not sufficient to be
considered "aggravation in service" unless the underlying
condition, as contrasted to symptoms, is worsened. Jensen v.
Brown, 4 Vet. App. 304, 306-307 (1993), citing Hunt v.
Derwinski, 1 Vet. App. 292 (1991).
It is the Board's responsibility to evaluate the entire
record on appeal. See 38 U.S.C.A. § 7104(a). When there is
an approximate balance in the evidence regarding the merits
of an issue material to the determination of the matter, the
benefit of the doubt in resolving each such issue shall be
given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §
3.102.
In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court
of Appeals for Veterans Claims held that an appellant need
only demonstrate that there is an "approximate balance of
positive and negative evidence" in order to prevail. The
Court has also stated, "It is clear that to deny a claim on
its merits, the evidence must preponderate against the
claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996),
citing Gilbert.
III. Factual background and analysis
The veteran contends that he sustained a gunshot wound to the
abdomen when he was accidentally shot during a raid by
Filipino guerrillas when he was imprisoned by the Japanese
during a period when he was not in creditable active military
service. He states that his subsequent period of recognized
active service aggravated the gunshot wound residuals; as a
consequence, he asserts that he now suffers from numerous
disabilities, such as abdominal pain, pleural effusions, and
chest pain.
The evidence which was of record when the Board considered
this case in September 1994 included the service medical
records (SMRs). At the time of his entrance onto active
duty, the veteran's abdominal viscera were reported as
normal. In August 1948, he was hospitalized with complaints
of recurrent attacks of pain in the left lower quadrant of
the abdomen with persistent pyuria and albuminuria. In
October 1948, he was transferred to another hospital. He
remained hospitalized until January 1949. He complained of
left lower chest pain. There was X-ray evidence of pleural
thickening; no other basis for the pain was identified. By
his discharge, he was asymptomatic, save for continuing
complaints of chest pain. He was found to be fit to return
to duty. The final diagnoses were prostatitis; pyelitis; and
chronic pleurisy in the left lower quadrant, which was found
to be secondary to a 1944 gunshot wound.
A WD Form 53 documents the veteran's creditable service from
April 1946 to February 1949; no prior service was noted. A
March 1961 VA Form 3101 from the service department certifies
that the veteran had no service as a member of the Philippine
Commonwealth Army, including the recognized guerrillas, in
the service of the U.S. Armed Forces.
An associate of the veteran stated in March 1954 that the
veteran had been captured by the Japanese in August 1943. A
March 1961 affidavit from another associate stated that they
had both been prisoners of war during World War II. Based on
this evidence, the Board denied entitlement to service
connection in July 1961, finding the evidence did not
demonstrate that the veteran's pre-existing gunshot wound
residuals had been aggravated by his period of active
service.
The evidence submitted subsequent to the Board's September
1994 denial includes a September 1966 statement from the
Philippine National Red Cross, which stated that the
"Prisoner-of-War Office" had determined that the veteran
had qualified for "Japanese Compensation".
An October 1991 VA examination contained a diagnosis of
status post gunshot wound.
The record also contained a June 1992 memorandum, which noted
that the service department had verified the veteran's 1946
to 1949 period of service. It was further verified that the
veteran had had no service with the USAFFE or as a recognized
guerrilla. In addition, his name was not on the POW
microfiche.
The veteran also filed a claim before the Foreign Claims
Settlement Commission of the United States. Documents
regarding this claim noted that in October 1954 a claim for
compensation had been denied because the Department of
Defense reported that the veteran had not been a member of
the Armed Forces of the United States for purposes of section
6 of the War Claims Act of 1948.
An undated medical certificate from Dr. A. indicated that the
veteran underwent a first rib resection due to thoracic
outlet syndrome in 1971. Private medical records developed
between 1995 and 1997 show that he was treated for chest
pain, a gastric ulcer, and degenerative joint disease.
The Philippine Veterans Affairs office issued certificates in
September 1992 and October 1995 which indicated that the
veteran had served during World War II. In September 1992,
the veteran filed a claim for correction of his military
record, arguing that he had had guerrilla service during
World War II. The service department acknowledged receipt of
his claim and, in July 1998, the service department indicated
that there would be no change in their prior certification of
his service.
The veteran testified at a personal hearing in January 1998.
He stated that when he was shot in 1944, he been a member of
the guerrilla forces and had been a POW.
The veteran also submitted a manifesto concerning the
treatment of Philippine veterans. He also submitted various
articles. One alleged that thousands of Philippine
guerrillas had not been properly recognized by the United
States. Another article discussed the use of Philippine
documents for immigration and naturalization purposes by the
United States.
The veteran has submitted multiple copies of many documents
that were already of record, to include treatment records and
affidavits from various associates. He has continued to seek
treatment for chest pain, arthritis, and a knee disorder. In
October 1999, he complained of abdominal pain that was
probably related to urinary retention. He was noted to have
a bladder neck contracture. VA records developed between
1995 and 2002 reflected treatment for degenerative disc
disease of the spine, a gastric ulcer, a left knee disorder,
and hammertoes.
In November 2002, the veteran's private physician submitted a
statement, in which she noted the veteran's history of a
gunshot wound to the abdomen in 1944. The SMRs were
reportedly reviewed, and the veteran was afforded an
examination. It was then stated that "[a]s a result of this
record review and examination, it is my opinion that it is at
least as likely as not that the patient's continuing
abdominal problems are the result of aggravation of his
gunshot wound which occurred in the line of duty." She
stated that the fact that the gunshot wound was incurred in
the line of duty was confirmed by the medical record.
In February 2003, the Army Board for Correction of Military
Records stated that they had not heard the veteran's case
because they do not have jurisdiction over former members of
either the Philippine Army or the organized guerrillas in the
Philippines.
The veteran submitted a July 30, 2002, statement from another
private physician, which again noted that the veteran had
sustained a gunshot wound to the abdomen in World War II. It
was then stated that "[h]e continues to have abdominal
difficulties that should contribute to his disability
rating."
In August 2003, the veteran complained of hematuria. Testing
revealed a probable hemorrhagic cyst. He was also diagnosed
with diabetes mellitus, severe peripheral vascular disease,
left eye blindness, and hypertension.
A September 6, 2002, statement from the veteran's private
physician again referred to his past gunshot wound. It was
stated that "[h]e continues to have abdominal difficulties
complicated with acute chest pain that should entitle him to
any disability compensation."
In August 2004, the veteran was noted to have post-traumatic
stress disorder, a hearing loss, tinnitus, arthritis,
arrhythmia, diabetes mellitus, arteriosclerotic heart
disease, and renal insufficiency. An April 2002 chest X-ray
showed small bilateral effusions and in July 2003, he was
noted to have hematuria due to moderate to marked prostate
enlargement.
In May 2004, the National Personnel Records Center stated
that a negative certification concerning guerrilla service
had been sent to the veteran. In February 2005, the Social
Security Administration noted that the veteran's file had
been destroyed.
In response to the Board's December 2005 remand, the
veteran's private and VA treatment records developed between
1994 and 2006 were obtained and associated with the claims
folder. These include the clinical records which had been
requested from Dr. E.D.G., from the Mission Medical Clinic.
Most of these records were duplicates of those already of
record; they showed the presence of abdominal scars, as well
as treatment for many unrelated disorders. However, no
rationale for the opinion offered by this physician in
November 2002 was included.
In July 2006, the veteran was afforded a complete VA
examination. The examiner noted that special attention had
been paid to the medical records, especially those developed
both before and after the veteran's 1948 period of
hospitalization. The examiner referred to the veteran's
history, noting his claim that he had been captured by the
Japanese on Mindanao. He said that he had been held as a
prisoner of war for 10 months (as noted above, however, there
is no objective evidence that the veteran had served as a
recognized guerilla prior to 1946 or had been a prisoner of
war). He said that he had been shot while attempting to
escape. The veteran also indicated that he had had
gallbladder surgery 30 years before, and had a history of
bladder stones. He also noted that in 1948 he had been
hospitalized for complaints of hematuria, which he claimed
was related to the gunshot wound residuals. He also noted a
history of prostatitis and pyelitis in service. He noted
that the entrance wound was on the right flank and the exit
wound was on the left upper quadrant.
The veteran's recent complaints were noted as having included
loose bowel movements with blood (for which he had not sought
treatment), chronic dysuria, lower abdominal discomfort, and
occasional pain in the right upper and lower abdominal
quadrants. He denied any epigastric distress. The examiner
then conducted an extensive and complete review of all the
records on file. Following this review, the examiner noted
that the veteran's left upper quadrant and small right flank
scars were consistent with a gunshot wound to the abdomen.
The large abdominal scar, in the absence of any evidence to
indicate otherwise, was at least as likely as not secondary
to an exploratory laparotomy, status post gunshot wound. In
response to the question of whether the veteran's service had
aggravated this injury beyond its natural progression, the
examiner stated the following:
The answer is that there is NO evidence that the
veteran engaged in any activities which aggravated
the 1944 gunshot wound residuals beyond any natural
progression. There is nothing in the 1948
hospitalization record to indicate (as he was
working as a guard on Okinawa) that he engaged in
any activities which caused "aggravation" of pre-
existing condition, the gunshot wound in 1944
(EPTS).
After a careful review of the evidence of record, the Board
finds that service connection for the residuals of a gunshot
wound have not been established. Initially, the Board notes
that there is clear and unmistakable evidence that the
veteran sustained a gunshot wound to the abdomen prior to his
1946 entrance onto active duty. This is supported by the
veteran's repeated statements that this wound had been
sustained in 1944. Despite his claims that he was acting as
a guerrilla at that time, was subsequently captured by the
Japanese, and was shot while attempting to escape from
captivity, repeated attempts to verify such recognized
guerrilla service and status as a prisoner of war have been
negative. In addition, the VA examiner in July 2006 opined
that, in the absence of any evidence to contrary, the
veteran's gunshot wound had occurred prior to his 1946 to
1949 period of service. This evidence clearly and
unmistakably demonstrates that the veteran had suffered a
gunshot wound to the abdomen prior to service.
There is also clear and unmistakable evidence that the pre-
existing abdominal gunshot wound was not aggravated by
service. The VA examination conducted in July 2006 included
review of the 1948 hospitalization report as part of the
determination as to whether the veteran's period of service
had aggravated his pre-existing gunshot wound residuals.
During this hospitalization, a pyelogram noted a possible
kidney stone, as well as nephroptosis of the right kidney
(described as a downward displacement of the kidney) which is
not necessarily an abnormality and which the examiner stated
was in no way related to the gunshot wound. He had been
admitted for complaints of recurrent pain in the left lower
quadrant, persistent pyuria, and albuminuria, and was
observed for a possible intestinal obstruction. The
diagnoses at discharge had included chronic pleurisy of the
left lower chest secondary to the 1944 gunshot wound.
However, it is also been noted that the veteran's present
complaints could not be related to the 1944 wound.
Based upon the above-described thorough review of the record,
the VA examiner opined that there was nothing in the
veteran's SMRs or subsequent treatment history which
suggested that his gunshot wound had undergone an increase in
severity beyond any natural progression as a result of his
service. With due respect to the November 2002 opinion of
the veteran's private treating physician in support of his
claim, the Board must note that this opinion, unlike the VA
examination of July 2006, does not provide any rationale or
explanation for the opinion proffered. Therefore, it must be
provided little, if any, probative weight. See Madden v.
Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997).
Moreover, although the veteran has expressed his belief that
he now has various abdominal complaints, pleural effusions,
and chest pain related to his 1944 gunshot wound and that his
service caused these to worsen, we must note that he is not
competent, as a layperson, to render an opinion as to medical
causation. See Espiritu v. Derwinski, 2 Vet. App. 492
(1992). The fact remains that there are no objective medical
records or opinions of record that would tend to suggest that
the veteran's pre-existing gunshot wound to the abdomen was
aggravated by his recognized service.
ORDER
Entitlement to service connection for the residuals of a
gunshot wound to the abdomen is denied.
_____________________________
ANDREW J. MULLEN
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs